By Michael Compain, MD
Advances in medical science and public health have steadily prolonged life expectancy in most of the developed world, but the prospect of an exploding population of elderly people has brought with it a host of new challenges. None of these is more formidable than the looming epidemic of Alzheimer’s. The personal, economic and social costs could be staggering, and governments and healthcare specialists are struggling to fashion a response.
On a personal level, individuals are naturally concerned about their own risk as they age. Although there are no perfect tests yet to predict the risk of developing Alzheimer’s, there is a good deal of research in this area. Certainly, one should look at family history as one component. One can also ask ones physician to perform an APO E4 test or measure homocysteine levels which are associated with increased risk.
The decision to embark on a program to reduce the risk or delay the progression to Alzheimer’s is a personal one based on inexact estimates of risk and inconclusive evidence regarding the effectiveness of prevention strategies.
With this in mind, one can begin to design a program of prevention. It should be mentioned, however, that many of the studies in this field have been epidemiologic, small in size or animal studies. Large, long term prospective studies have not been done.
The first place to start is usually to look at one’s diet, and there have been many studies looking at the correlation of diet and Alzheimer’s. The most dramatic findings have been with the Mediterranean Diet. This diet contains mostly whole grains, vegetables, fruits, fish and nuts, and a small amount of dairy and meat. It is high in olive oil and alpha linoleic acid.
There have also been studies looking at some of the individual components of the diet. Fish consumption, nuts and produce have been associated with decreased incidence of Alzheimer’s. Plant flavonoids and dietary antioxidants have also been reported with lower disease incidence. AGEs (Advanced Glycosylated End Products) have been shown to have a negative impact on cognitive function and Alzheimer’s (as well as other degenerative diseases), and these compounds are derived from sugar in the diet.
In addition to diet, another lifestyle intervention is exercise, and here there is also epidemiologic evidence that Alzheimer’s and cognitive decline are less common in those who exercise regularly. Exercising one’s mind with new experiences, intellectual stimulation, puzzles, etc. may have a beneficial effect as well.
Two of the major metabolic processes that contribute to neurodegenerative conditions like Alzheimer’s are oxidative stress and inflammation. (In fact, many of the chronic illnesses that afflict us are caused by this pair.) Oxidative stress is the damage done to our tissues by ‘free radicals’ which are to some extent derived from oxygen. Inflammation involves stimulation of the immune system, and in the brain this is mediated by cells called microglia.
Antioxidants are compounds that ‘quench’ free radicals. They are obviously components of the dietary elements mentioned above, but they can also be taken as supplements. It is thought by some that antioxidant therapy is more effective if a variety of agents are taken together rather than high doses of individual agents. Some of the antioxidants that may have particular benefit in neurodegenerative diseases such as Alzheimer’s are Lipoic Acid, N-acetyl Cysteine, Coenzyme Q10, Vitamin E, Vitamin C and Vitamin D (which has many other properties as well).
Inflammation can be approached in a variety of ways. It is generally believed that a diet high in animal fat might contain levels of arachidonic acid which can promote inflammation. Conversely, Omega 3 oils such as EPA and DHA from fish oil can be anti-inflammatory and have been proposed as possibly neuroprotective. Phosphatidyl serine, which has been used to improve cognitive function, has been shown to reduce microglial activation, hence reducing brain inflammation. Another agent which has been studied extensively is Curcumin, an ayurvedic remedy that is anti-inflammatory and quite safe to use.
A final element of any program to prevent or slow Alzheimer’s involves environmental toxins. The toxin that has received the most attention is aluminum, and it is generally advised to avoid commercial antiperspirants with aluminum hydroxide and to minimize use of aluminum foil. Other agents that are known to be neurotoxic are heavy metals such as lead, cadmium, and mercury (which can be tested in individuals) and pesticides which are used in homes and gardens and are in our food supply. One should consider avoiding these agents and consuming a more organic diet.
A program such as this is by no means a guarantee, but offers the possibility of preventing or delaying the challenges of this all too common disease.